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Guide to Adult ADHD

A few decades ago, doctors believed that ADHD (Attention Deficit Hyperactivity Disorder, also known as ADD) was a childhood condition that everyone outgrew. But research has shown that around 50 percent of children diagnosed with ADHD will have symptoms of the condition as adults and require treatment. More than 4 percent of American adults are thought to have ADHD. Like children with ADHD, adults with ADHD have trouble focusing to the point where it affects their work, family life and social relationships. They can also be impulsive, but hyperactivity becomes less common, which is part of the reason adult ADHD can be difficult to diagnose.

ADHD doesn't develop in adults; it must be present since childhood. However, not all adults with ADHD have been diagnosed as children. For one thing, medical professionals, educators and parents were not as skilled at recognizing ADHD decades ago as they are today. Also, some very bright individuals, as well as those from very structured, supportive home environments, may have been able to compensate for their ADHD during childhood, but have trouble coping when college, career or family life require more multi-tasking and focus.

Not everyone with ADHD exhibits all the symptoms of the condition, and effects can range from mild to severe. However, for some ADHD can lead to a stalled careers and troubled relationships because of behaviors like chronic procrastination, difficulty completing tasks, volatile temperament and an inability to listen without interrupting. Several long-term studies of individuals with ADHD have shown that they have lower levels of academic and job success than those without the condition and more troubled personal lives. This in turn can lead to feelings of failure, frustration and unhappiness. Adults with ADHD may suffer from other mental conditions as well, notably depression, and are three times more likely to have substance abuse issues.

Because ADHD is thought to be hereditary, many adults with ADHD face the additional challenge of parenting children who have the same condition. Their struggle is to overcome their own symptoms and create an organized, supportive environment so their children can thrive and succeed. In other words, parents have to control ADHD so it doesn't end up controlling them, recreating the same problems for another generation.

The good news is that many people with ADHD lead happy, successful lives -- especially if they receive appropriate treatment. The vast majority of adults with ADHD symptoms respond well to treatment with stimulant drugs, and behavioral therapy (learning to change negative and destructive behavior patterns). Because adult ADHD is now widely recognized, there are also support groups and social networks in most communities and online so that ADHD adults -- especially parents -- can connect with others dealing with similar problems.

Adult ADHD has the same characteristics as childhood ADHD: inattention and distractibility, restlessness and impulsivity. However, two things distinguish true, clinical ADHD from ordinary distractibility and forgetfulness in adults. First, the symptoms of inattention and hyperactivity must be so severe that they are disruptive to a person's life in at least two of three areas -- work, home and social life. Second, a pattern of symptoms -- even if they have changed over time -- must have first started in some form before age 7. Adults do not suddenly develop ADHD; it's a lifetime spectrum disorder that starts in childhood.

As with childhood ADHD, adults can have one of three subtypes of the condition, primarily inattentive, primarily hyperactive/impulsive, or a combination. But these symptoms play out differently in adults.

Inattentive Type

The ADHD child who forgot his crayons may develop into the college student who shows up for the wrong exam or the lawyer who fails to file key court papers on time. Or she might be a homemaker who can't cope with daily tasks like laundry and picking up kids from school. ADHD adults often progress from having messy rooms as kids to having disorganized work spaces, cars and houses.

Hyperactive/Impulsive Type

An ADHD adult isn't going to run circles around the conference table, but he may interrupt his colleagues constantly with irrelevant comments, drum his fingers on the table and leave meetings frequently for no reason. He'll start 10 projects and finish few. No one wants to be his partner for a presentation.

Combined Hyperactive-impulsive and Inattentive Type

Combine impulse buying with an inability to focus on unpleasant tasks, such as balancing a bank account or paying bills, and it's easy to see why ADHD adults can sometimes have financial problems. She may also have constant relationship drama and an inability to stick with one partner for any length of time.

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CAUSES

No one's exactly sure what causes ADHD, whether in adult or children, but scientists believe it could be in imbalance in neurotransmitters, the chemicals that regulate how the brain processes and regulates responses to stimuli. Genetics may also play a role. Like many mental conditions, along with other traits ranging from diabetes to alcoholism to red hair, ADHD seems to run in families. However, since the disorder (called minimal brain dysfunction or hyperactivity in previous decades) may have gone undiagnosed, parents will have to look for clues on their family tree. School failures, delinquency, multiple divorces, employment problems and addictions can all be signs that family members may have had undiagnosed and untreated ADHD.

It's much harder to diagnose ADHD in adults than in children. If someone has a documented medical history of childhood ADHD, it's simpler. But twenty or more years ago, when today's adults were kids, ADHD was not as well recognized as it is now, and many children went undiagnosed and untreated. When those adults seek diagnosis and treatment, clinicians not only have to eliminate other possible causes for their symptoms, they must assess their current and childhood behaviors (remember, it's only ADHD if it's been present since childhood.)

Also, since stimulants, the drugs most often used to treat ADHD, can be abused by adults, doctors are under pressure to get the diagnosis right. For this reason, your family physician may feel more comfortable referring you to a specialist, such as a psychiatrist, with experience in diagnosing ADHD.

Not everyone with a messy desk, urge to spend, or failed marriage has ADHD. Adults have complex, time-consuming lives and everyone forgets the occasional doctor's appointment or lets the laundry pile up. In fact, studies show that half to two-thirds of the people who self-diagnose are not found to have clinical ADHD. Ironically, adults who actually do have ADHD are often unaware of their condition -- they're used to the chaos and figure they just can't get a break. It can take the intervention of a spouse or friend, or the diagnosis of their child, to make them realize that their behavior is out of normal range and may be the result of a mental condition, not laziness, incompetence or bad luck.

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When to Talk to Your Doctor

Signs that a person should consider getting evaluated for ADHD include:

A history of academic or professional underachievement

Inconsistent work performance

Difficulty managing daily responsibilities, including finances

Difficulty with relationships due to forgetfulness and volatile temperament

As with children, the first step will be a thorough review of a patient's medical records and a physical exam. Other physical conditions can mimic ADHD symptoms, so those will need to be ruled out. In adults, sleep apnea and medication side effects can also cause inattention and hyperactivity. Doctors will also want to exclude other mental conditions, like depression and bipolar disorder; however, these can also co-exist with ADHD. It's easy for someone self-diagnosing via Google to confuse these conditions, but a skilled clinician should recognize the difference and treat accordingly.

You'll be asked to self-evaluate using a checklist of symptoms. Some doctors use the DSM-IV (R) criteria, while others use several other rating scales. For example, you may given a list of questions such as "How often do you feel restless and fidgety" and be asked to select options ranging from "Never" to "Very often."

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PREVENTION

You can't do much to prevent ADHD -- more and more research links it to genetics. But you can take steps to keep it from wreaking havoc on your life. Simple strategies adults with ADHD can use (with or without medication) include:

Use calendars. Large wall calendars or computerized calendars and reminders can help you keep appointments and knock off to-dos.

Keep your work area distraction-free. Clutter-free work areas and desks without windows can help you stay on task.

Know your best time of day. Adults with ADHD can learn to be in tune with their "internal clock" and schedule demanding tasks for the time of day when they are at their best.

Set firm time limits. For example, only check email or Facebook every hour, or limit yourself to one favorite TV show.

Use technology as a reward. If you finish your work, you can use your Blackberry.

Unplug! It's harder to crawl under a desk and plug in a computer than it is to just turn it on.

Local ADHD support organizations, often run by those who have been in treatment for years, are also good sources of information on organizational techniques.

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THE ADHD FAMILY

A long term study of 200 preschool children with ADHD recruited at the University of Pittsburgh and University of Chicago found that parents of kids with this condition are 24 times more likely to have ADHD than parents of children without ADHD. It's a small sample, but given what researchers say about the role of genetics in ADHD, it makes sense that many ADHD adults are parenting ADHD children. That means they face the daunting task of overcoming their own organizational and attentional problems so they can create a calm, structured home environment and manage all the paperwork, appointments and medication required for their children.

Although it's natural for parents to forget themselves and focus on their children, in this case you are helping your child by helping yourself. Parents who suspect they have ADHD should seek treatment in order to function at the level necessary to really support and advocate for their children. It's like the airline safety remind to put your own oxygen mask on first so you're still conscious and can help your child.

PARENTS WITH ADHD RAISING CHILDREN WITH ADHD

Parenting a child with ADHD can be difficult, but when a parent also has the disorder too it can make for a very chaotic home. Here are some tips to help you rise to the challenge:

Provide consistent structure and schedules at home. The more routine and predictable your family life is, the easier it is for you and your child to understand and do what needs to be done.

Keep an ADHD notebook. Pull together a binder of all your child's records and educational plans related to ADHD and automatically put in everything referring to your child's problems. Then it will all be in one place when you need it for a meeting with the teacher, your family physician, etc. No more searching through piles of paper.

Outsource your paperwork. Does gathering all the paperwork for the notebook feel like a Herculean effort? Hire a highly-organized friend to help you gather and file all of your child's paperwork, so all you'll need to do is maintain.

Share the burden. If you have a spouse or family member who does not have ADHD, be sure that person takes on parenting tasks that are more difficult for you to do effectively. Be sure you are in agreement about expectations, rules, and discipline. Family counseling can help you discuss and formulate your shared parenting goals, rules and responsibilities.

There is no "cure" for ADHD, but your doctor will suggest a number of treatment strategies that can help control your symptoms and make it easier to lead a normal, happy, successful life. Common treatment strategies include a combination of medication and behavioral therapy.

Therapy

Counseling, ADHD coaching or psychotherapy can help adults deal with ADHD, most often in combination with medication. Some forms of counseling, often called coaching or behavioral therapy, teach new methods of organization and dealing with ADHD behaviors like impulse buying and bursts of anger. Counseling can also help those with ADHD deal with the fallout of the condition, and poor self esteem caused by failed jobs and relationships. Couples or family counseling is especially helpful because often adult ADHD has as much impact on spouses and children as it does on the individual with the condition. If a parent with ADHD also has a child or children with the condition, parent training can help with strategies to better structure the home environment and family schedule for both parent and child.

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MEDICATION

The first line of treatment for ADHD is stimulant medications such as Ritalin or Adderall. Experts estimate that 80 percent of all adults with ADHD get immediate symptom relief from stimulants. (Learn more about these and other stimulants here) For doctors, the response to stimulants is an indication of the accuracy of their diagnosis; if the drugs work, the patient's symptoms probably were the result of ADHD. (There are of course instances where patients are not responsive to the stimulant.) Stimulant side effects are generally less pronounced in adults than children.

If stimulants prove ineffective, Strattera, a non-stimulant, has been approved for use in adults. Strattera increases the levels of the neurotransmitter/hormone norepinephrine to the brain. Researchers think this chemical plays a key role in focus and attention. This drug may also reduce anxiety. Strattera can cause some rare but very serious side effects, including jaundice and other liver problems, and suicidal thinking.

Antidepressants are not approved for treating ADHD, but are sometimes used "off label" to treat adults with ADHD when stimulants don't work. Antidepressants have more unpleasant side effects, including weight gain and loss of interest in sex, than stimulants.

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ALTERNATIVE AND COMPLEMENTARY MEDICINE

Currently, medical evidence does not support the idea of alternative therapies for ADHD, although there is some promising research into certain diets and neurofeedback, a form of biofeedback where subjects look at visual images of their brainwaves and learn to control them -- therefore controlling the ADHD behaviors that produce them.

No legit scientific evidence backs up megadoses of vitamins or herbal remedies for ADHD, and these supplements are so poorly regulated that you can never be sure what you are buying.

If you do wish to explore complementary therapies (those done in conjunction with, rather than as an alternative to, conventional medicine), try those that are first of all harmless, and second can benefit your health in some way, even if they're not proven for ADHD. Examples include yoga or eliminating food additives from your diet. But always consult your doctor first.

Your clinician may want to review work or school records, so ask for copies of performance reviews and school records, and bring them to your appointment. Adults with ADHD are often less aware of their condition than others around them, so your doctor may want to interview your spouse or partner or close friends. It's a good idea to bring your partner or a friend for support, to take notes (you may be too overwhelmed to remember everything the doctor says), and to give an outside perspective on your behavior and history. Your doctor may also want to interview your parents and even give them questionnaires about your childhood behaviors.

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PARENT'S EXPERIENCE

Fifteen years ago Lew Mills, now 53, realized his daughter was having trouble with social relationships. He also realized that he had some issues with completing tasks (it had taken him 30 drafts to finish his PhD thesis). But even though he's a psychologist and his then wife is a psychiatrist, they didn't recognize the symptoms in their own family.

His daughter, Erica, now 24, was diagnosed that year in the fourth grade, but Mills went to several doctors before being diagnosed. Both he and Erica are bright and not hyperactive, which made their ADHD more difficult to recognize. Several years later Mills son Matthew, now 17, was also found to have ADHD.

"The hardest thing was just staying organized," says Mills of being an ADHD parent with two children with ADHD. "Having a kid means remembering who you have to pick up from a soccer game and who has to go to the dentist. I wasn't particularly good at it. I was always making excuses and apologies, and that was very stressful."

Mills and both his children were treated with stimulants, which he says "made a huge difference." Erica and Matthew also had therapy and coaching. The family used elaborate calendars to keep track of schedules and planned everything well in advance. "Everything has to be overly organized not to fall apart," says Mills. He also admits that it is very helpful to have one parent without ADHD to keep things under control.

"I think you can raise kids successfully. I think it takes more energy and commitment than you'll ever know coming in. All the years in teachers' or principals' offices the advocacy, research and, work that goes into it is immense. But I think you can have a really good outcome. In some way it's helped my kids to face some adversity," says Mills.